主动脉瓣置换术后产生高跨瓣压差的临床原因分析及治疗  

Reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement

作　　者：李金东[1] 武艳红[1] 董铭峰[1] 王建堂[1] 柴守栋[1] 唐培哲[1] 柳涛[1] 栗振坤[1] 夏峰[1] 马胜军[1] 

机构地区：[1]山东省聊城市人民医院心外科,252000

出　　处：《中国医师进修杂志》2016年第10期883-886,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：分析主动脉瓣膜置换术后高跨瓣压差产生的原因及治疗措施。方法回顾性分析45例行主动脉瓣置换术后发生高跨瓣压差患者的临床资料，术后平均随访24.6（12～40）个月，行经胸彩色多普勒超声检查，测量术后人工瓣膜的有效瓣口面积（EOA），与不同种类及型号的人工瓣膜的参考EOA对比，可分为测量EOA＝参考EOA和测量EOA＜参考EOA。在测量EOA＝参考EOA时，参照人工瓣膜的参考EOA和患者的体表面积（BSA）计算人工瓣膜有效瓣口面积指数（EOAI），可分为EOAI＞0.85 cm2/m2和EOAI＜0.85 cm2/m2。根据上述不同标准分析主动脉瓣置换术后产生高跨瓣压差的原因。结果45例主动脉瓣膜置换术后出现高跨瓣压差患者中，人工瓣膜-患者不匹配（PPM）33例；术后人工瓣膜失功10例，其中发现血栓5例（3例加大华法林用量后好转；2例再次行主动脉瓣置换术治疗），生物瓣严重钙化3例（再次行主动脉瓣置换术治疗），2例人工瓣环血管翳形成影响瓣叶活动（再次行主动脉瓣置换术治疗）；左室流出道血流速度增快2例，患者无明显不适，未做特殊处理。死亡4例，其中2例为重度PPM，另外2例为非心源性死亡。结论 PPM是主动脉瓣置换术后产生高跨瓣压差的最主要原因，选择合适的治疗方案，可提高患者生存率。Objective To analyze the reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement. Methods The clinical data of 45 patients with high transprothetic pressure gradient after aortic valve replacement were retrospectively analyzed. The patients were followed up for average 24.6 （12 - 40） months. The postoperative effective orifice area （EOA） of artificial valve was measured by transthoracic color Doppler ultrasound. Compared with published referred EOA of different artificial valve, there were 2 kinds results：measured EOA=referred EOA and measured EOA〈referred EOA. If the measured EOA =referred EOA, the effective orifice area index （EOAI） was calculated according to the artificial valve referred EOA and body surface area （BSA）, and EOAI was divided into EOAI〉0.85 cm2/m2 and EOAI〈0.85 cm2/m2. The reasons of high transprothetic pressure gradient were analyzed according to the above different standard. Results In the 45 patients with high transprothetic pressure gradient after aortic valve replacement, prosthesis-patient mismatch （PPM） was in 33 cases, and prosthetic dysfunction was in 10 cases, among whom 5 cases were because of thrombus （3 cases improved after increasing the dosage of warfarin, 2 cases underwent re-aortic valve replacement）, 3 cases were because of severe bioprosthetic calcification （underwent re-aortic valve replacement）, and 2 cases were because of prosthetic ring pannus and influenced movement of the leaflets＆nbsp;（underwent re-aortic valve replacement）. High flow in the left ventricular outflow tract occurred in 2 cases. The patients had no obvious discomfort, and did not receive special treatment. Four cases died, among whom 2 cases were because of severe PPM, and the other 2 cases were because of noncardiac. Conclusions Many reasons can result to the high transprothetic pressure gradient, and the PMM is the most common reason. Choosing the right treatment plan can improve the survival rate of patients.

关 键 词：心脏瓣膜疾病 心脏瓣膜 人工 回顾性研究 

分 类 号：R654.2[医药卫生—外科学]